Care Home: Longcroft

What the care home does well The manager is experienced in managing a care service and this was shown in how Person centred thinking and planning had been introduced into the care of people living at the home so the care of people using the service was arranged around their lifestyles and needs and they are supported to regain balance in their lives. People receive care and support from the staff team with respect and relationships in the home are formed with a non judgemental approach from the staff. People living at the home experience enduring mental health needs and they are supported to live a lifestyle of their choosing balanced with the need long term care so they have stability in their lives. People living at the home are at risk of committing offences and their care and support needs to be carefully planned. We saw during the visit that all risk and measures to reduce them were made so each person living there had an individual plan to support them to reduce their individual risks. People living at Longcroft said they enjoyed living there and despite restrictions on them found the home a positive place to live. A person living at the home said, `What is good about being here I suppose is the rules. I do not really like rules but you have to have them and we have to keep to them. The rules keep me safe, and I do not do the things that make me ill. At least here I am treated OK and as a person`. We received surveys from social and health care professionals who commented on the level of support and care and the quality of the service offered at Longcroft. Comments from them were, `I have worked very closely with Longcroft and find they offer an excellent service where people grow as individuals and gain in confidence. They have helped out people in difficulty when funding has not been available and people moving on say it is a safe and secure place to live`, `The support staff always appear helpful and conscientious` and `The service respects the residents and meets their needs , cultural, religious and ethnic`. Collaborative working between the home, police, probation services and NHS continues based on good communication from the home. These arrangements were clear in care and support plans so people living at the home have a range of professional support. People living at the home have access to and take part in a range of educational, social and recreational activities so they are offered opportunities for personal development and to gain experience and skills in managing their mental health, lifestyle and reduce the incidences of them re offending The meals at the home were varied and appetising and meals are prepared mainly from fresh ingredients so people have healthy meals. People living at the home feel that they are listened to and consulted about their care and support so they are included in everyday decisions about their lives. People that use services had access to a complaints procedure so could be confident they can raise concerns so they will be acted upon. The home demonstrated a commitment to staff training with a varied staff training programme taking place so staff were provided with training and support to do their jobs. The home provides a clean and comfortable place to live so people that use services live in a homelike environment with access to local amenities. Appropriate staffing levels are provided so people that use services were supported around their needs and staffing levels are increased as activities and demands rise. What has improved since the last inspection? Information for staff about the health care needs of people living at the home has improved so they are aware of any health problems or symptoms that people may be experiencing and know what to look out for and seek the necessary advice. Medication management and administration has improved with the home doing its own regular checks on staff practise and procedures so mistakes in administration and management have reduced. The maintenance of the building has improved with regular checks on the health and safety of the building so the manager can plan for repairs and redecoration when necessary. In 2010 the home is reviewing the use of shared bedroom facilities so people living at the home have the choice of all single accommodation. The home is now a smoking free environment so people who do not smoke are not at risk of developing smoking related illnesses. The care Quality Commission is kept informed of any events or matters that arise in the home that affects the welfare of people living there so we can be confident the home is managed to promote their health and welfare. What the care home could do better: We could not see any improvements as the manager and management team were aware of what improvements needed to be made to the service so the home is proactive in improving the facilities and services provided. We received surveys from health and social care professionals and a comment received was that the home could be improved by them having more access to drugs and alcohol workers for people from outside the area who live at Longcroft. The manager is aware of the difficulties in accessing these services locally and is discussing this with the local NHS provider services. Key inspection report Care homes for adults (18-65 years) Name: Address: Longcroft 58 Westbourne Road Lancaster Lancashire LA1 5EF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anthony Cliffe     Date: 1 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Longcroft 58 Westbourne Road Lancaster Lancashire LA1 5EF 0152464950 01524844082 Longcroft@langleyhousetrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Langley House Trust care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The home shall accommodate a maximum of 14 Service Users in the category MD (mental disorder). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Longcroft provides personal care and accommodation for up to 14 younger adults with mental health needs. The home is one of a number operated by the Langley House Trust, which is a charitable organisation. The home is situated close to Lancaster City Centre and near to a number of facilities and amenities. It is a large detached property set within its own well maintained grounds. Care is provided on a 24 hour basis including waking watch support throughout the night. The home works closely with professionals from other agencies including local probation and mental health services in meeting the needs of people living there. Information about the home and the current range of fees can be obtained from the registered manager of the home. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 14 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: References to we, our or us represent the Care Quality Commission. This unannounced visit took place on the 14th December 2009 and lasted over six hours. One inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since the last visit, to provide us with up to date information about the services provided. This helps us to determine if the management of the home see the service they provide in the same way we do and if our judgements are consistent with home owners or managers. During the visit various records and the premises were looked at. People that use Care Homes for Adults (18-65 years) Page 5 of 30 services, managers and staff were spoken with and gave their views about the service. We provided questionnaires to people using the service, staff and health and social care professionals involved in their care so they can give us their views and opinions about how the service is managed and how it meets the needs of people and what outcomes it provides for people using the service. We also shared a meal with people living at the home and staff. In March 2009 we did an annual service review of the home, which told us the home was still providing a good service. An annual service review is a summary of our knowledge about how a service that has not had a visit in the last year is still performing. It is also how we decide if a service is still as good as we thought it was since our last visit or annual service review. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: The manager is experienced in managing a care service and this was shown in how Person centred thinking and planning had been introduced into the care of people living at the home so the care of people using the service was arranged around their lifestyles and needs and they are supported to regain balance in their lives. People receive care and support from the staff team with respect and relationships in the home are formed with a non judgemental approach from the staff. People living at the home experience enduring mental health needs and they are supported to live a lifestyle of their choosing balanced with the need long term care so they have stability in their lives. People living at the home are at risk of committing offences and their care and support needs to be carefully planned. We saw during the visit that all risk and measures to reduce them were made so each person living there had an individual plan to support them to reduce their individual risks. People living at Longcroft said they enjoyed living there and despite restrictions on them found the home a positive place to live. A person living at the home said, What is good about being here I suppose is the rules. I do not really like rules but you have to have them and we have to keep to them. The rules keep me safe, and I do not do the things that make me ill. At least here I am treated OK and as a person. We received surveys from social and health care professionals who commented on the level of support and care and the quality of the service offered at Longcroft. Comments from them were, I have worked very closely with Longcroft and find they offer an excellent service where people grow as individuals and gain in confidence. They have helped out people in difficulty when funding has not been available and people moving on say it is a safe and secure place to live, The support staff always appear helpful and conscientious and The service respects the residents and meets their needs , cultural, religious and ethnic. Collaborative working between the home, police, probation services and NHS continues based on good communication from the home. These arrangements were clear in care and support plans so people living at the home have a range of professional support. People living at the home have access to and take part in a range of educational, social and recreational activities so they are offered opportunities for personal development and to gain experience and skills in managing their mental health, lifestyle and reduce the incidences of them re offending The meals at the home were varied and appetising and meals are prepared mainly from fresh ingredients so people have healthy meals. People living at the home feel that they are listened to and consulted about their care and support so they are included in everyday decisions about their lives. People that use services had access to a complaints procedure so could be confident they can raise concerns so they will be acted upon. The home demonstrated a commitment to staff training with a varied staff training programme taking place so staff were provided with training and support to do their Care Homes for Adults (18-65 years) Page 7 of 30 jobs. The home provides a clean and comfortable place to live so people that use services live in a homelike environment with access to local amenities. Appropriate staffing levels are provided so people that use services were supported around their needs and staffing levels are increased as activities and demands rise. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move into Longcroft so they know their needs can be met. Evidence: As part of the arrangements for moving in people that may choose to live at the home can visit and spend time to get to know the other people that live as well as staff so they can familiarise themselves with the home. This includes visits during the day and overnight so they can get to know the other people that live there. The home gathered the necessary information on the needs of people using the service and this included information from the mental health services involved in the care of people using the service and the Care Programme Approach, care programme, Mental Health Tribunal notes, medical and discharge summaries so important information about the mental health needs of people using the service was sheared among those involved in their care. Where arrangements for people that use services had been agreed to live at the home from the Mental Health Tribunal, probation services or other mental health services details were also available in care files with details of any conditions and support to be provided. The information we saw was detailed and provided Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: information about people that use services, their mental health history, medication, support needs and potential areas of risk so staff could arrange care based on their needs. We saw that gathering information involved Professionals such as probation officers, social workers and mental health specialists so people with knowledge of people that choose to live at Longcroft had been involved in the decision about living there. Before people move to Longcroft professionals involved in their care must complete and application form with them and support their application to live there. This includes Longcroft providing people choosing to live there with a referral pack which contains all the information about the facilities available at Longcroft as well as the house rules so people are aware of the facilities and agreed boundaries they must live within. Before people move into Longcroft a multi agency public protection agreement is put in place so agencies such as the police, probation, local council and local NHS agree a risk assessment for all areas of the persons life so they and the public are protected and the right level of resources and support agreed. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live their preferred lifestyles while agreeing to live a healthy and safe lifestyle are listened to and included in the decision making process. So are supported by staff who know how to manage their individual risks and support their needs. Evidence: Information gathered about the needs of people using the service was detailed and outlined their needs, as well as areas of potential risk. Support and care plans and documents that identified where people that use services were a risk to the health and welfare of others and themselves called risk assessments were completed and reviewed at least every three months or as needed so staff were aware of how to support people that use services to live a safe lifestyle. The home recorded if risk assessments in place were working and supported people that use services to live a healthy and safe lifestyle and work within the guidelines of the multi agency public protection agreement and Care Programme Approach care plan from the local mental health services so staff knew what to do if they needed help. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: The information we saw included support for personal care, managing alcohol and drugs, health, recreation, lifestyle and family contact. People that use services also agreed what they wanted to achieve in the future and their dreams and aspirations recorded so staff would know the personal goals of people living at the home. Each person had information gathered about what was important to them and for them so staff provided care based on the wishes of people that use services. This included information about their daily routines and how they wanted their care or support to be arranged and if they were a risk to themselves or others what agreements they had to follow so they remained safe. Examples of this were if people had to have staff with them when they went to the local community or if they had supervised visits with family. This was included in the information gathered about person centred care. We saw that staff treated people that use services with courtesy, dignity and respect and sought their views about how they wanted to be supported and saw staff help them make decisions. We saw information about how people that use services made decisions or where they lacked capacity, experience or judgement to make decisions how this may lead them to be a risk to themselves or others so could see how staff supported people that used services to make decisions. Examples of this were in risk assessments for people managing their own medicines or where they had agreed restrictions due to their vulnerability. People living at the home were on formal aftercare programme which was monitored by the mental health services called the care programme approach so the mental health needs of people living at the home had support should they need it. Their mental health needs were monitored via reviews and visits and strategies in place should the mental health of people that use services deteriorate so they could get the right help. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services are supported to maintain relationships where appropriate and make choices about lifestyle and leisure activities so have control over their lives and a lifestyle based on their personal choices within agreed limitations. Evidence: We saw that people living at the home chose to spend their day as they wished so could decide on their lifestyle. People had a variety of leisure pursuits such as attending college, voluntary and conservation work, gardening, cooking and cleaning at the home so they were involved in everyday activities. Staff at the home do not usually help people with their personal bodily care so are not involved in helping people with their personal bodily care unless necessary. The home has a workshop for repairing bikes so people living at the home maintain their bikes and have transport around the city centre. People living at the home have also made their own furniture and one person was making a wardrobe for when he moved to his own Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: accommodation. People living at Longcroft had also landscaped the garden area and made decorative Japanese bird tables as well as seating for the garden area. Some people that lived at the home had made floral designed pictures from plants they had grown in the garden. Their pictures had been photographed and looked professional in their presentation. The home are to have these framed as well as putting the pictures onto greeting cards so people can see how good their work is. A person living at Longcroft said off their experience of living there, I cannot complain about being here. I look after my birds and am doing some painting at the moment. We have an art teacher and I have learnt a lot. There is plenty to do, music, gardening and going out. I feel Lucky to be here. The home has also been involved in piloting a magazine for the Langley House Trust, which is a charitable organisation. A person living at the home had produced the magazine from start to finish and had written and compiled all the articles and information as well as editing and producing it. The magazine looked very professional in its presentation so the Langley House Trust may use it as a model for all the registered services it operates. The music room was seen during the visit and this was used for relaxation as well as people pursuing their own hobbies. The music room was equipped with musical instruments and people living at the home can have music lessons and learn to play a musical instrument so learn new things. The home also provides opportunities for people to do painting and the music room was filled with pictures painted by people who lived or were living at Longcroft. One person also keeps budgerigars so follows his personal interests. The basement provides a games room which is equipped with a snooker table and dart board as well as a variety of board games so people have the opportunity so socialise with one another. There are necessary restrictions on people having access to the community due to the nature of the needs of the men living at Longcroft. These are individually risk assessed and in partnership with other professionals regularly reviewed for each person. People living at the home are encouraged to work toward increasing the time they spend in the community but in a very structured and closely managed way so they can show they are making progress and working with staff at Longcroft and the agencies involved in their care and support. Some of the people at the home are involved with the catering. Meals were cooked by the chef and people living at the home could make drinks and snacks as they wished and some cooked their own meals so could do everyday things for themselves. Breakfast was a choice of cereals and twice a week people could have a cooked breakfast. During the visit we shared a meal with people living at Longcroft and staff. The main meal of the day is at lunchtime when people living at the home have an opportunity to eat together with staff so there is an opportunity to socialise as well as Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: a sense of community. One of the people living at the home had prepared a fresh salad and was helping the chef cook a choice of Mediterranean chicken and cottage pie. People living at Longcroft praised the person for the salad and the meal. The chef also shared a meal and said he enjoyed teaching people living there how to cook healthy meals from fresh ingredients and said the home did not use frozen or processed foods and encouraged healthy eating. The evening meal was a choice of lighter hot snacks so people had a varied menu from which to choose. The person who had helped the chef talked about how he enjoyed helping with the cooking and said, I have been cooking with the chef this morning and helped him cook the chicken. I did the salad and the chef said it was good, and the other residents and staff have said I did a good job. I help out with the cooking twice a week. The other days I am at college doing English language and maths and go into town. I feel really good about being here. I have only been here a month but I have learnt and done so much it feels like two months. People using the service were complimentary about the meals and a person living there said, The food is great and lots of choice. I tend to eat when I want to and they provide for my diet and know what I like and I eat what I want. I like breakfast as its flexible. I do not get out of bed till late but can still get something to eat. I spend a lot of time in my bedroom but no one hassles me about that. It is a good place . Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical, emotional and personal needs of people using the service were cared for and they received support to look after their medicines or support to take them safely so their health and welfare was promoted. Evidence: People that use services and staff at the home were supported by the community mental health services and included support from community mental health nurses and a psychiatrist so had good consistent professional support. The home funds its own psychiatrist, counsellor and psychologist as people living at the home may not have access to theses services immediately if they are not from the local area. These visit the home weekly and liaise with the other professionals involved in the care and support of people living at Longcroft so there is god communication between the home and other professionals involved in their care. Additional support was available form General Practitioners, occupational therapists, opticians, dentists and district nurses. People living at the home chose their daily living routines, managed their own personal care, and come and go as they pleased so took responsibility for their health. We could see that people had regular monitoring of their blood when they were prescribed medicines to control their mental health symptoms so had regular health Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: checks. We saw that staff at the home were monitoring the health of people using the service and helping them keep fit, loose weight and look after their health conditions. If people that used services wished they could make their own doctors appointments and see doctors in private so were responsible for their health. We received surveys back from two doctors that said staff always sought advice about the health needs of people using the service and acted on the advice given. People that use services said they had a balanced diet which varies form a cooked breakfast to main meals and snacks. People that use services said they enjoyed their meals so were satisfied with their diet and the home provides a variety of meals based on religious and cultural preference. We looked at the arrangements for medicine. Medication policies were detailed so staff had guidance on how to receive, store, administer, record and dispose of medicines safely. The home had a medicine cupboard for the storage of medicines which was safely secured. Policies and procedures for medicine administration were kept in the managers office with specimen signatures for the staff responsible for the management and administration of medicines so staff were aware of their responsibility and accountability for managing and administering medicines. No controlled drugs were stored at the time of the visit but the home has storage facilities should anyone be prescribed them. Some people managed their own medicines and the home had completed documents called risk assessments so they could decide if people that use services could take their medicines safely. Medication was supplied from a local pharmacy. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services are protected by the safeguarding adults procedure in place so people that use services will be confident they are protected at all times. Evidence: We looked at the complaints records kept at the home and no complaints had been received by the service and we had not received any either. The records of people that use services we looked at contained copies of the complaints procedure so people that use services were aware of how to make a complaint. We could see from the relationships between people that use services and staff that they related well to one another. People that use services said they could say if they were unhappy with anything so were comfortable in raising concerns or complaints. We received surveys from people that live at Longcroft that said they knew how to make a complaint and who to speak to if they had concerns. They said that staff and managers were always respectful and listened to what they said. There are regular meetings for the people that live at Loncroft. Minutes of these meetings were read and there is clear involvement in them of those people who wish to do so, so they can raise any matters. People living at the home have access to their own key worker to discuss any concerns or issues or, if needed, the registered manager so there is someone they can raise concerns with if they wish. Policies and procedures were in place to protect vulnerable adults called the Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: safeguarding adults procedures. The safeguarding adults procedure is how we, the local council, police and other agencies respond to and manage allegations or suspicions of abuse against vulnerable adults. The manager provided recruitment records that recorded staff had received the safeguarding adults policies and guidance. Staff had received training on how to recognise and respond to suspicions of abuse so we can be confident staff will be able to protect vulnerable adults. We spoke to two staff and they said they had received safeguarding adults training while employed at Longcroft and were aware of the procedure to follow should they need to report an allegation of abuse or neglect. Staff were issued with guidance on the standards expected of them so they were aware of their responsibilities and practise when providing care to people that use social care services. Staff also had access to the whistle blowing policy, which is a policy they could follow if they needed to tell members of the public or other organisations about things in the care home that concerned them and needed to be placed in the public interest. The home had a copy of the Lancashire County Council safeguarding adults procedure. We saw that safeguarding adults training had taken place throughout 2009. Staff training provides information on safeguarding adults and information on the management of violence and aggression, self harm and boundaries for staff involvement so staff have clear procedures to follow and are aware of their accountability and responsibility to protect people. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services live in a comfortable and safely maintained building and improvements in the facilities benefit people living at the home so they live more independently. Evidence: We looked around the building and saw one of the bedrooms of a person living at the home. We saw that the basement had been refurbished with the creation of more office space, games area and laundry facilities. There are a number of communal areas in the home. The main lounge has a large crack in the ceiling and the manager has already made arrangements for this to be repaired. People living in the home now have external facilities for those that smoke so the building is a smoking free area. We could see that there were CCTV cameras in a number of communal areas in the home mainly corridor area. Cameras are not placed to be intrusive and we accept that these are necessary to meet the needs of the people living there so safety and security is maintained. The presence of cameras is stated in the information provided to people before they move in so they are aware of their use. Since the last visit bathrooms have been updated and windows replaced. Other improvements include a roofed area so bike maintenance can be carried out. Upgrading of the indoor cycle shed and creation of an outside space for the wood Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: workshop so people working with wood and sawdust do not work in a confined space. Redecoration and improvement of four bedrooms, including replacements of carpets and furnishings. The refurbishment of the main office is nearing completion with additional PC workstations. In January 2010 the central heating boilers are due to be replaced which is a major refurbishment to the home. The manager discussed how the home will be heated while this work is ongoing so people living at Longcroft will remain warm and comfortable. The home still has a three shared bedrooms but two are only in use. The manager is to review the use of the shared bedrooms in 2010. Overall the building provides a warm, comfortable and clean environment for the people that live there. The redecoration and improvements have added to the facilities provided so the living conditions at the home are improved. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good employment policies are in place that ensures the home has a competent and well trained staff so that staff are supervised and supported to do their jobs. Evidence: We saw the staff numbers in place supported the needs of people that use services so they had sufficient help with their needs. There were six staff on duty as well as the manager with additional staff on duty to assist with planned activities outside of the home with people living there. Staff supported people that use services to keep their bedrooms and the home clean and the home use a cleaning contractor to clean the home. Staff do not generally assist people that live there with bodily personal care and additional staff from a domiciliary care agency are used to provide this level of personal care when needed. Staff we spoke with described training as good and they could have additional training if needed so they were kept up to date with working practise. Staff had received training on a variety of subjects. Staff said they had the opportunity to complete NVQ level 3 qualifications which area nationally recognised qualification in social care. The information returned to us before the visit by the manager said 12 staff were employed 5 had NVQ level 3 qualifications so all staff had access to a qualification in social care. New staff are provided with a detailed induction programme and as each area of this is completed it is signed of by the person supervising the staff member so that senior managers can confirm that staff receive a Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: consistent induction programme. Each member of staff is provided with a staff handbook and code of conduct by the home so they are aware of their responsibility and accountability when doing their job. We examined the recruitment records of three staff employed at the home. Recruitment procedures were completed and included staff having to complete an application form, full employment history and two references sought about their suitability for employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. Staff were also issued with the General Social Care Council code of practise a guide for social care staff on the standards expected of them so they were aware of their responsibilities and practise when providing care to people that use social care services. Staff were provided with a variety of training which included health and safety, food hygiene, safeguarding adults, medicine management and dealing with difficult and aggressive behaviour. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A positive, respectful and open culture supported by quality assurance identifies how the service can improve so areas for further development are identified so the quality of life and personal development of people that use services is promoted. Evidence: The manager had worked at the home for many years and is experienced in managing the home and has the necessary experience to manage the home supported by a management team who balance the security and protection of people that live there against ensuring that they and members of the public are safe and treated with dignity and respect so a positive respectful culture is promoted within the home. We saw many positive interactions between staff and people that live there and we received many positive comments from people living at the home as well as professionals involved in their care so the home is seen as a positive place to live and supports the personal development of the people living there. We looked at how the quality of life for people living at the home was promoted. We saw the responsible individual and manager completed some checks on things in the Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: home on behalf of the Trust to make sure the home was managed properly, important information was gathered about the home, how safety was maintained and that people that lived there were satisfied with the care they received. This was called quality assurance and was done by doing lots of checks called audits so the Trust could see the home how everything was working and was aware of any matters in the home which needed to be improved upon and could tell the manager if he was doing a good job or needed to make improvements. The Trust had employed someone that new about quality assurance to complete monthly quality assurance checks on their behalf. This person is called a responsible individual. This involved talking to people that live at the home and staff and looking at important records so they can write a report to say if the think the home is being properly managed. These visits are called Regulation 26 visits. The responsible individual visited the home regularly and completed reports on behalf of the registered provider. We saw these reports and they looked at how the building was being maintained, talking to people that live there about the standards of care and food provided and to staff about training so important matters were discussed with people living and working at the home. During the visit the responsible individual spoke with people living at the home so they could give their views about living there and they said they were happy living at Longcroft. Regular meetings between the manager and people living at the home were held so people that use services hand an opportunity to discuss the management of the home and the manager could discuss matters about health and safety and living together. We looked at how the Mental Capacity Act, a law about making decisions and what to do when people cannot make some decisions for themselves, was used in the home. When people cannot make decisions for themselves, this is called lacking capacity. The Mental Capacity Act sets up safeguards that must be used when a person living in a care home, who cannot make decisions for themselves, is restricted in a way that deprives them of their liberty. This provides extra protection for them to make sure that anything being done is done in their best interests. Sometimes people may be stopped doing things they want to do, to give them extra protection. This may restrict them and might be done to keep them safe or protect them from harm. We saw that where an application had been made to deprive a person this had been declined as it was not in the persons best interest to safeguard their welfare as other less restrictive options were available. The AQAA told us that all the required maintenance checks and health and safety checks had been completed as required so people that use services lived in a safe building. We checked the records for fire safety and found all fire safety systems were Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: checked regularly so the safety of people that lived at the home was promoted. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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